How doctors get groomed

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In my last post, I talked about the patient filling gaps in healthcare. Dedicated to researching how we can help improve care for other people with diabetes, and how health care providers can be more empathetic and present with patients – what I see as critical to care for people who live with a chronic condition – I love reading books written by doctors that describe their world. 

I’ve already shared I’m a big fan of physician/authors’ Danielle Ofri and Rachel Naomi Remen and I’m currently reading the book, “Intern” by Sandeep Jauhar.

Jauhar describes his first year as a resident at a big city hospital. As he points out, efficiency and getting through rounds seeing patients is more important than any quality time spent with patients. It’s a stunning, shocking, eye-opening revelation how grueling medical training is, how little “care” is actually given patients and how the process all but completely trains empathy out of burgeoning doctors. 

Here’s are a few excerpts:

“By this point in my internship, I had already come to appreciate that there was a fundamental disconnect in the hospital. Good relations with patients weren’t rewarded; efficiency was, which meant focusing on the work at hand, operating with a kind of remote control, in front of computer screens and nursing charts and requisition forms, and on the phone. Face-to-face time was a relatively insignificant part of the job. The high counters around the staff workstation delineated not just a workspace but a type of kingdom, too. It might as well have been ringed by a moat…

If internship was supposed to stoke intellectual curiosity, I never saw it. Like me, most of my classmates seemed disengaged, mentally exhausted. With patient rosters of fifteen or more each, we were preoccupied with getting our work done. Anything that got in the way- even a bona fide medical mystery- was more often seen as a bother than a learning opportunity…

The worst was when you were alone with patients and you realized you knew next to nothing about them. They’d be on bi-level positive airway pressure ventilation or something, and you didn’t want to go through the chart to figure out why, but you felt guilty, so you hedged and read a little bit and learned a little bit, and read some more and discovered some more, and you realized how much you learned was dependent on how deeply you were willing to look, and what was pushing you was a sense of duty, but the cut was ill defined and couldln’t you just ignore it and go home? …

There was a constant tug of war between desire and duty: Your desire was to get the hell out of the hospital and have a life; your duty was to be a good doctor… If you did everything you were overwhelmed. If you didn’t you felt guilty…So I compensated by writing off-service notes, hoping someone on the next rotation would address the issues my team had ignored.”

As Jauhar writes as well, for all the work loaded on nurses’ shoulders without equivalent power, they are the force in a hospital who can make your life hell or tolerable. 

I find the book engrossing and it helps me to understand the fierce pressure, competition, opposing forces, desire not to show any weakness or ignorance and time constraints being a good, kind and caring medical professional costs in our healthcare system. It’s a sad and unfortunate revelation.

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